Shinwell E S, Blickstein I, Lusky A, Reichman B
Department of Neonatology, Kaplan Medical Center, Rehovot, Israel.
Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F145-8. doi: 10.1136/adc.2002.021584.
To study the effect of birth order on the risk for respiratory distress syndrome (RDS), chronic lung disease (CLD), adverse neurological findings, and death in very low birthweight (VLBW; < 1500 g) twins.
A population based study of VLBW infants from the Israel National VLBW Infant Database. The sample included all complete sets of VLBW twin pairs admitted to all 28 neonatal intensive care units between 1995 and 1999. Outcome variables were compared by birth order and stratified by mode of delivery and gestational age, using General Estimating Equation models, with results expressed as odds ratio (OR) with 95% confidence interval (CI).
Second twins were at increased risk for RDS (OR 1.51, 95% CI 1.29 to 1.76), CLD (OR 1.36, 95% CI 1.11 to 1.66), and death (OR 1.24, 95% CI 1.02 to 1.51) but not for adverse neurological findings (OR 1.20, 95% CI 0.91 to 1.60). Mode of delivery did not significantly influence outcome. The odds ratio for RDS in the second twin was inversely related to gestational age, and the increased risk for RDS and CLD was found in both vaginal and caesarean deliveries.
VLBW second twins are at increased risk for acute and chronic lung disease and neonatal mortality, irrespective of mode of delivery.
研究出生顺序对极低出生体重（VLBW；<1500g）双胞胎患呼吸窘迫综合征（RDS）、慢性肺病（CLD）、不良神经学表现及死亡风险的影响。
基于以色列国家极低出生体重婴儿数据库对极低出生体重婴儿进行一项人群研究。样本包括1995年至1999年间入住所有28个新生儿重症监护病房的所有完整的极低出生体重双胞胎对。采用广义估计方程模型，按出生顺序比较结局变量，并按分娩方式和胎龄分层，结果以比值比（OR）及95%置信区间（CI）表示。
第二个出生的双胞胎患RDS（OR 1.51，95%CI 1.29至1.76）、CLD（OR 1.36，95%CI 1.11至1.66）和死亡（OR 1.24，95%CI 1.02至1.51）的风险增加，但不良神经学表现风险未增加（OR 1.20，95%CI 0.91至1.60）。分娩方式对结局无显著影响。第二个出生的双胞胎患RDS的比值比与胎龄呈负相关，且在阴道分娩和剖宫产中均发现患RDS和CLD的风险增加。
极低出生体重的第二个出生的双胞胎患急慢性肺病及新生儿死亡的风险增加，与分娩方式无关。
